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Connecticut My Name Change Affidavit

Official state formLegal name changeFree downloadLast verified November 10, 2026

Notarized affidavit that asks the town clerk of the town of birth to change the name on your birth certificate after a Probate Court decree changed your name. It goes to the town clerk, not to the state office.

Who can use this form

  • The person whose name was changed signs the affidavit before a notary public.
  • The office's corrections and amendments page says the adult named on the birth certificate must make the request. The form does not print this.
  • The form refers to a name change decree entered by a Probate Court.

What to send with it

  • The notarized affidavit, addressed to the town clerk of the town where you were born.
  • The form says you are submitting a copy of the Name Change Decree.
  • The office's page, not the form, asks for the original certified legal name change court order, which is returned on request.
  • The office's page, not the form, also asks for government issued photo ID from the requester.

Where to send it

Mail to
See the form for where to file it.
State fee
The office's corrections and amendments page says there is no processing fee for amendments or corrections. The form states no fee.
Typical processing
Not provided
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Connecticut My Name Change Affidavit | Connecticut Form